In an uncommon demonstration of agreement, 41 medical organizations delivered a consensus document to CMS calling for quick coverage of low-dose CT lung cancer screening for high-risk patients.
The action comes in the midst of a national coverage analysis initiated by CMS on February 10, prompted by the B-level recommendation for coverage from the United States Preventive Services Task Force (USPSTF) in December of 2013. Within the consensus document are joint recommendations for LDCT lung cancer screening quality metrics, screening patient eligibility, appropriate frequency and duration of screen, and precise criteria for test positivity, among other recommendations.
The USPSTF recommendation called for screening adults aged 55 to 80 years who have a 30 pack-year smoking history and either still smoke or have quit within the past 15 years. Calling lung cancer the leading cause of cancer death in the United States for both men and women, the consensus document calls for swift national coverage for the patients identified as high risk in by USPSTF.
Among the signatories of the letter submitted online yesterday are The Lung Cancer Alliance, The Society of Thoracic Surgeons, and the American College of Radiology (ACR). “Lung cancer kills more people each year than breast, colon and prostate cancers combined,” said Douglas E. Wood, M.D., immediate past president of The Society of Thoracic Surgeons, in a prepared statement. “For each of these other three cancers, there are well established screening tests and programs. We strongly urge CMS to implement broad national coverage so that those at high risk, can be screened, providing the opportunity to save thousands of people each year from this terrible disease.”
A potential loophole that could limit the impact of the USPSTF recommendation was pointed out by Lung Cancer Alliance president and CEO, Laurie Fenton Ambrose: While the Affordable Care Act (ACA) requires private insurers to cover all medical exams or procedures that receive a grade of B or higher from the USPSTF without a co-pay, the ACA does not specify that Medicare provide full national coverage for beneficiaries. “The USPSTF’s recommendation that made lung cancer screening an essential health benefit specifically included 65 to 80 year olds who are also part of the Medicare population,” Ambrose said in a prepared statement. “If Medicare does not extend full coverage for lung cancer screening to this population, the net effect will be a two-tier system that leaves Medicare beneficiaries at greater risk of dying from lung cancer than those with private insurance. This cannot be right.”
The radiology community has been instrumental in gathering the evidence on which the USPSTF based its decision, most recently and decisively, the National Lung Cancer Screening Trial, which demonstrated that CT lung cancer screening is cost effective and significantly reduces reduce lung cancer mortality in the high-risk population.
“CMS should act on the USPSTF recommendation to provide national coverage for high-risk Medicare beneficiaries and support quality screening programs across the country,” said Paul Ellenbogen, M.D., FACR, chair of the American College of Radiology Board of Chancellors in a prepared statement. "This would, for the first time, enable healers and patients to strike a major blow against the nation’s leading cancer killer."